The issue over whether to require health plans in Michigan to cover autism care comes down to an old debate: Coverage mandates that drive up the costs, versus improving access to treatment that could ultimately lead to lower costs in the long-run through early intervention.

Backers are vowing what Hope Network CEO Phil Weaver calls a “full-court press” this fall to win approval of legislation to require health insurers to pay for autism care, which many parents are often unable to afford for their children unless their insurance carrier covers it.

To Weaver, the legislation makes good sense both medically and economically.

Getting children with an autism diagnosis into treatment at an early age can improve their condition and better enables them to become productive adults who otherwise may end up on Medicaid if they are deemed disabled, Weaver said.

“We have to deal with this as a society,” Weaver said.

Hope Network, which provides outpatient and inpatient care for individuals with autism, is part of a statewide coalition backing the legislation.

Weaver cites a 2006 Harvard School of Public Health report that shows the cost of caring for people with autism is also significantly less over their lifetime by getting them into early treatment: $2.0 million, versus $3.6 million for later intervention.

The cost of requiring insurers to pay for treatment would drive up health premiums less than 1 percent, Weaver said, citing early data from states that have passed autism legislation.

“That’s a pretty minor cost for all of us” that can lead to larger overall savings over the years, Weaver said.

“This is pretty simple for taxpayers,” he said.

Beyond the economic issues, Weaver asserts the legislation is simply “the right thing to do.” Health insurers should treat autism just as they do any other medical condition or disability, Weaver argues.

“These are children. … I don’t understand why, as a society, we don’t give them a chance to succeed,” he said, also noting the financial and emotional burdens families face when they are unable to afford treatment for an autistic child.

“Just like anything else, the younger we can address the issue, the greater opportunity for success,” Weaver said. “All we’re talking about is treatments that other people get for their disease or disability.”

His argument runs head-on into the escalating cost of health coverage — which in West Michigan now costs an average of more than $1,000 a month for a family plan, according to an annual cost survey — and a general disdain by business advocates for coverage mandates that drive up costs.

The state House in 2009 passed bills mandating autism coverage, but the legislation never got a vote in the Senate, largely because of objections to coverage mandates. New versions of the bills were re-introduced this past spring.

While the cost of providing autism coverage is incremental, it is still an added cost, and even small increases add up over time, say those who oppose new coverage mandates.

“It’s also a question of where do you stop when it comes to mandated benefits? Where do we draw the line?” said Andy Johnston, vice president of government affairs at the Grand Rapids Area Chamber of Commerce.

Employers and their employees, Johnston and others say, should draw that line, not legislators.

“As a matter of principle, these decisions about health care coverage and other employee benefits should be made in the marketplace by employers and employees,” Michigan Chamber of Commerce CEO Rich Studley said.

But that option is limited for employers, even if they are willing to buy autism coverage.

Blue Cross Blue Shield of Michigan in 2009 began offering employers with mental health coverage the option to buy coverage for intensive early intervention for children with autism.

“We recognize that all families care about their children. We believe that we have been more progressive than other Michigan insurance companies in addressing autism,” Blue Cross Blue Shield spokeswoman Helen Stojic said. “To the best of our knowledge, we are the only insurer in Michigan to offer this coverage option.”

As a compromise to the issue, the Michigan Chamber supports a “mandated offer” that would require health insurers to offer autism coverage to employers to buy for employees who want it.

“We would be open to that,” said Studley, calling a mandated offer a “more market-oriented solution.”

Weaver responds that the push for mandated coverage stems from insurers not offering it.

"The two options are mandate or choice. Today, insurance companies have the choice to provide coverage for children with autism and the majority are not providing any coverage," he said. "We need to ensure that children with autism have a greater opportunity for independence, and if the insurance companies are not going to choose to cover it, like they cover diabetes or cancer, then we need to support a mandate."